Not only wasteful, tests can lead to unnecessary treatments for patients.

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TUESDAY, March 13, 2012 (HealthDay News)
— Contrary to current guidelines, a majority of
American primary care physicians are ordering some form of lung
cancer screening test for patients who lack any symptoms of disease,
a new national survey reveals.

The findings stems from responses to a questionnaire completed by
962 family physicians, general practitioners and general internists between
2006 and 2007.

"There is no authoritative group that is recommending lung
cancer screening for asymptomatic individuals," said study author Carrie
Klabunde, an epidemiologist from the applied research program within the
division of cancer control and population sciences at the U.S. National Cancer
Institute.

"And guidelines are developed by expert groups that generally
have a very thoughtful process for evaluating scientific evidence and for coming
to a consensus," she added. "So, it's important to be aware of what
the guidelines for lung cancer screening are. Because in this case, the
available screening technology really hasn't shown a strong benefit, and when
used improperly can lead to what may end up being a medical misadventure."

The findings appear in the March/April issue of the Annals
of Family Medicine.

In the United States, lung cancer is currently the leading cause of
death due to cancer, according to study background information. Survival rates
are much lower for lung cancer than for many other types of cancer.

That said, fresh concerns about pointless lung cancer screening
raised by the new poll follow a related U.S. National Cancer Institute (NCI)
analysis conducted last fall using data on more than 150,000 people. It
concluded that chest X-rays are of no benefit when it comes to screening for
lung cancer or curtailing lung cancer mortality, although more expensive CT
scans were cited as a potentially more effective option.

The current study team said that no vetted investigation has ever
shown that X-ray screenings help to lower the risk of dying from lung cancer.

Apart from wasting medical resources, unnecessary screening can do
more harm than good, experts say. False test results can cause undue patient
stress and false positives can raise the risk for patient harm resulting from
unneeded and invasive treatment.

As a result, experts do not currently recommend a lung cancer
screening for a patient who does not show signs of disease, even if that
patient has a history of heavy smoking.

Klabunde and her colleagues mailed out a survey to assess the
frequency and physician rationale behind the ordering one of three different
lung cancer screening techniques: chest X-ray, low-radiation dose spiral CT
scan and/or sputum cytology
(a lab test).

All the respondents were 75 years old or younger and currently in
practice.

The result: 57 percent of those polled said they had ordered at
least one of the three tests in the past year for patients who lacked lung
cancer symptoms.

The study team found that fully a quarter of the polled physicians
said they mistakenly believed that one or more of the relevant national expert
organizations (including the U.S. Preventive Services Task Force, the American
Cancer Society, the American College of Radiology, the American Thoracic
Society and the NCI) did in fact recommend lung
cancer screening for patients with no symptoms.

Those who believed this to be the case were more likely to have
ordered screening tests. Similarly, those doctors who themselves believed that
such testing was effective and, therefore, something they would recommend for
asymptomatic patients were also more likely to order the tests.

Physicians whose patients had specifically inquired about getting a
lung cancer screening were also more likely to order a test. Two-thirds of
physicians said that at least one of their patients had questioned them about
screening in the year leading up to the poll.

The survey team concluded that the apparent "disconnect"
between expert screening
guidelines and common physician practice raises the need for improved
outreach to educate primary care physicians about best practices, as well as
continued monitoring of what's actually going on in doctor's rooms across the
country.

"Primary care physicians have to know about so many different
areas," Klabunde acknowledged. "And there are a lot of guidelines for
preventive services. So it's a lot to keep in his or her head."

"But one thing that I think will help going forward are
electronic medical records systems," she said. "Many of which,
although not all, have decision-support features. And this can provide
physicians who are considering ordering a screening with electronic links to
practice guidelines."

Dr. Otis Webb Brawley, chief medical officer and executive vice
president of the American Cancer Society, said that it's important to
understand that screening can be a "double-edged sword."

"I am constantly concerned when we promote the benefit of
screenings, and don't worry about the fact there might be associated
harm," he said.

"I would say, however, that most of the doctors in this survey
have been practicing for 25 or 30 years," Brawley noted. "And because
we are starting to teach about screening in school now I am somewhat hopeful
that the word will get out among younger physicians. But I would also say that
the only way we're really going to get doctors better on this question is
actually by encouraging patients to turn to the large major established
organizations like us and the NCI - and get more educated about the
facts."

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